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Seizures and epilepsy after intracerebral hemorrhage: an update

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Abstract

Seizures are common after intracerebral hemorrhage, occurring in 6–15% of the patients, mostly in the first 72 h. Their incidence reaches 30% when subclinical or non-convulsive seizures are diagnosed by continuous electroencephalogram. Several risk factors for seizures have been described including cortical location of intracerebral hemorrhage, presence of intraventricular hemorrhage, total hemorrhage volume, and history of alcohol abuse. Seizures after intracerebral hemorrhage may theoretically be harmful as they can lead to sudden blood pressure fluctuations, increased intracranial pressure, and neuronal injury due to increased metabolic demand. Some recent studies suggest that acute symptomatic seizures (occurring within 7 days of stroke) are associated with worse functional outcome and increased risk of death despite accounting for other known prognostic factors such as age and baseline hemorrhage volume. However, the impact of seizures on prognosis is still debated and it remains unclear if treating or preventing seizures might lead to improved clinical outcome. Thus, the currently available scientific evidence does not support the routine use of antiseizure medication as primary prevention among patients with intracerebral hemorrhage. Only prospective adequately powered randomized-controlled trials will be able to answer whether seizure prophylaxis in the acute or longer term settings is beneficial or not in patients with intracerebral hemorrhage.

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Authors and Affiliations

  1. Stroke Center, Department of Neurology, Neurological Hospital, Hospices Civils de Lyon, University of Lyon, 59 boulevard Pinel, 69677, Bron cedex, France

    Laurent Derex

  2. Research On Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France

    Laurent Derex

  3. Department of Functional Neurology and Epileptology, Hospices Civils de Lyon, University of Lyon, Lyon, France

    Sylvain Rheims

  4. Lyon 1 University, Lyon, France

    Sylvain Rheims & Laure Peter-Derex

  5. INSERM U1028—CNRS UMR 5292, Lyon Neuroscience Research Center, Lyon, France

    Sylvain Rheims & Laure Peter-Derex

  6. Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, University of Lyon, 103 Grande rue de la Croix-Rousse, 69004, Lyon, France

    Laure Peter-Derex

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  1. Laurent Derex
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Laurent Derex and Sylvain Rheims have nothing to disclose. Laure Peter-Derex is the principal investigator of the PEACH trial (Clinicaltrials.gov, NCT 02631759).

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Derex, L., Rheims, S. & Peter-Derex, L. Seizures and epilepsy after intracerebral hemorrhage: an update. J Neurol 268, 2605–2615 (2021). https://doi.org/10.1007/s00415-021-10439-3

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